Pedunculated Focal Nodular Hyperplasia of the Liver

Abstract

Focal nodular hyperplasia (FNH) is the second most common type of benign liver tumour, and it is more frequently encountered in young women and the right hemi-liver. Most patients are asymptomatic, and there is no malignant potential. Thus, the current guidelines do not recommend any treatment for uncomplicated FNH, and surgery is indicated only for some atypical patients (with complications or uncertain diagnosis). Pedunculated forms are atypical, rare features of FNH and appear to be more frequently associated with complications. We hereby report the case of a 40-year-old woman diagnosed at computed tomography with a lobulated subhepatic FNH with a long pedicle originating from segment III of the liver, which was successfully resected. Pedunculated FNH is associated with a challenging diagnosis and may require resection in order to avert potential complications such as compression of surrounding organs or torsion of the pedicle.

Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature

“…(2018) [ 7 ] Female/3 Abdominal distension 5.9 cm Right hepatic lobe Normal US, CT, and MRI Surgery N/A No (history of preterm birth) Martiniuc et al . (2018) [ 13 ] Female/40 Asymptomatic 4.2 cm × 5 cm Seg 3 Normal US and contrast enhanced CT Surgery No complications No Navarini et al . (2020) [ 6 ] Female/26 Acute abdomen and a palpable mass in the epigastrium 13 cm × 7 cm Left hepatic lobe N/A MRI Surgery N/A N/A Alfayez et al .…”

Is there any special imaging finding in a pedunculated focal nodular hyperplasia with suspected torsion?

“…Focal nodular hyperplasia [1][2][3] is a benign liver tumor that usually does not require surgery [4]. The diagnosis is challenging for rare pedunculated forms of www.ijcasereportsandimages.com…”

Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out?

“…To date, several authors have reported pedunculated cases of FNH, while most of them were associated with clinical symptoms that required intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Recently, Akaguma et al [ 31 ] successfully performed laparoscopic surgery for pedunculated FNH in a female patient during pregnancy due to the increased risk of developing complications and severe clinical manifestations.…”

“… The segmental distribution of pedunculated or exophytic FNH cases for the adult and pediatric population, based on the literature review [ 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. IVC, inferior vena cava; GB, gallbladder; FNH, focal nodular hyperplasia.…”